Commentary by an adult and child psychoanalyst and parent - infant psychotherapist at the Anna Freud Centre

Jane is a child who has suffered the extremes of abuse, neglect, relational trauma and abandonment from her earliest infancy, compromising her development at the most profound level. The therapist describes a picture of her at referral that is entirely consistent with this history: she has severe problems with object constancy; her sense of self is incoherent; her capacity for self-object differentiation unstable; her capacity to

regulate her affective states extremely problematic; she cannot play; fantasy and reality are confused etc. This kind of child severely challenges conventional psychoanalytic technique. The deficits in her psychic development consequent upon her experiences mean that she does not have the psychic structure within which to experience and own mental conflict. The kind of therapeutic technique that presumes she is able to have an internal conflict and thus able to respond, albeit defensively, to interpretations about that conflict, will risk compounding her difficulties in being in contact with an external object such as the therapist. Jane does have the advantage now of being in a stable and permanent home, she has a therapist whom she sees three times per week and so from an external point of view there is now a setting within which these difficulties can be addressed and new experiences provided. The Anna Freudian tradition of ‘developmental therapy’ (Hurry, 1998), which modifies classical technique in order to address psychic deficits, may enable Jane to some degree to make good some of the deficits she suffers.

The session with which we are provided is the last before the Easter break 1 year into treatment. Separation for Jane is extremely problematic as it challenges any growing sense of self-object relationships that may be accruing as a result of the reliability of the therapy. It also threatens to disrupt her fragile sense of object constancy. One would expect her to deploy primitive defences in order to manage her exploding anxiety.